14 Dec Most Patients Who Died of COVID-19 Were Receiving Intensive Hospital Care

MedicalResearch.com Interview with:

Dr. Chua

Isaac Chua, MD, MPH
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital

MedicalResearch.com: What is the background for this study?

Response: Patient surveys have shown that most people prefer to die at home at the end-of-life. However, during the initial wave of the COVID-19 pandemic, anecdotal evidence from our colleagues and findings from a prior study published in the Journal of the American Geriatrics Society suggested that majority of COVID-19 decedents died in a medical facility. However, less is known about care intensity at the end-of-life according to place of death among patients who died of COVID-19. Therefore, we characterized end-of-life care by place of death among COVID-19 decedents at Mass General Brigham (MGB), the largest health system in Massachusetts. 

MedicalResearch.com: What are the main findings?

Response: The main finding is that 95.5% of COVID-19 decedents ended up dying in the hospital, of which 40% died in the intensive care unit ICU. Among the 4.5% of patients who died outside the hospital, only 1.7% of all decedents died at home or in an assisted living facility. 

MedicalResearch.com: What should readers take away from your report?

Response: The majority of individuals who died of COVID-19 ended up dying in the hospital, of which many received high intensity end-of-life care. Our findings illustrate the difficulty for patients with COVID-19 to die at home.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Additional research needs to be done to better understand caregiver and patient end-of-life preferences for patients who are dying of COVID-19. Although most people report a preference of dying at home in general, inpatient care (e.g., in-hospital or inpatient hospice) may very well be the preferred place of death among caregivers and patients due to the significant caregiver burden required to care for a patient dying of a highly infectious and life-threatening illness at home. That said, more research should be done on how to best implement home hospice, or other advanced home-based care, so that patients who do feel strongly about dying at home will be able to achieve that wish safely and effectively.

Any disclosures? We do not have any conflicts of interest to report. Dr. Isaac Chua reports funding from IBM Watson for work in artificial intelligence in oncology, separate from the current work. Co-authors Dr. David Levine reports a PI-initiated study of artificial intelligence at home funded by Biofourmis, separate from the current work; and Dr. Sandra Shi is funded by T32AG023480.

Citation:

Chua IS, Shi SM, Levine DM. Place of Death and End-of-Life Care Utilization among COVID-19 Decedents in a Massachusetts Health Care System. J Palliat Med. 2020 Nov 17. doi: 10.1089/jpm.2020.0674. Epub ahead of print. PMID: 33210957. 

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Last Updated on December 14, 2020 by Marie Benz MD FAAD